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Resuscitation. 2019 Aug;141:24-34. doi: 10.1016/j.resuscitation.2019.05.032. Epub 2019 Jun 5.

The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest.

Author information

1
The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States. Electronic address: topjian@email.chop.edu.
2
The University of Utah, Department of Pediatrics, Salt Lake City, UT, United States.
3
The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
4
The CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States.
5
C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, United States.
6
Children's Hospital of Michigan, Detroit, United States.
7
Hospital for Sick Children, Toronto, Ontario, Canada.
8
Children's Hospital Los Angeles, Los Angeles, CA, United States.
9
Primary Children's Hospital, Salt Lake City, UT, United States.
10
Children's National Medical Center, Washington, DC, United States.
11
Children's Hospital of Philadelphia, Philadelphia, PA, United States.
12
Washington University, St Louis, MO, United States.
13
Children's Medical Center Dallas, University of Texas Southwestern Medical School, United States.
14
Morgan Stanley Children's Hospital-ColumbiaUniversity Medical Center, New York, NY, United States.
15
Phoenix Children's Hospital, Phoenix, AZ, United States.
16
Duke Children's Hospital, Durham, NC, United States.
17
Anne and Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States.
18
University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
19
University of California, San Francisco Benioff Children's Hospital, United States.
20
Seattle Children's Hospital, Seattle, WA, United States.
21
Penn State Children's Hospital, Hershey, PA, United States.
22
University of Rochester Medical Center/Golisano Children's Hospital, Rochester, NY, United States.
23
Kosair Charities Pediatric Clinical Research Unit, Department of Pediatrics, University of Louisville and the Kosair Children's Hospital, Louisville, KY, United States.
24
Medical College of Wisconsin, Milwaukee, United States.
25
Mattel Children's Hospital UCLA, University of California, Los Angeles, United States.
26
Children's Healthcare of Atlanta, Atlanta, GA, United States.
27
Children's Hospital of Orange County, Orange, CA, United States.
28
Children's Hospitals and Clinics of Minnesota, Minneapolis, United States.
29
The Children's Hospital of Alabama, Birmingham, United States.
30
Cincinnati Children's Hospital, Cincinnati, OH, United States.
31
Johns Hopkins Children's Center, Baltimore, MD, United States.
32
Rainbow Babies and Children's Hospital, Cleveland, OH, United States.
33
Nationwide Children's Hospital, Columbus, OH, United States.
34
Loma Linda University Children's Hospital, Loma Linda, CA, United States.
35
University of Tennessee Health Science Center, Memphis, United States.
36
University of Texas Health Sciences Center at San Antonio, United States.
37
Diamond Children's Medical Center, Tucson, AZ, United States.
38
Arkansas Children's Hospital, Little Rock, United States.
39
Outcome Center, Kennedy Krieger Institute, and Johns Hopkins University, School of Medicine, Baltimore, MD, United States.
40
National Heart, Lung, and Blood Institute, Bethesda, MD, United States.
41
Data Coordinating Center, University of Utah, Salt Lake City, United States.

Abstract

AIM:

Approximately 40% of children who have an in-hospital cardiac arrest (IHCA) in the US survive to discharge. We aimed to evaluate the impact of post-cardiac arrest hypotension during targeted temperature management following IHCA on survival to discharge.

METHODS:

This is a secondary analysis of the therapeutic hypothermia after pediatric cardiac arrest in-hospital (THAPCA-IH) trial. "Early hypotension" was defined as a systolic blood pressure less than the fifth percentile for age and sex for patients not treated with extracorporeal membrane oxygenation (ECMO) or a mean arterial pressure less than fifth percentile for age and sex for patients treated with ECMO during the first 6 h of temperature intervention. The primary outcome was survival to hospital discharge.

RESULTS:

Of 299 children, 142 (47%) patients did not receive ECMO and 157 (53%) received ECMO. Forty-two of 142 (29.6%) non-ECMO patients had systolic hypotension. Twenty-three of 157 (14.7%) ECMO patients had mean arterial hypotension. After controlling for confounders of interest, non-ECMO patients who had early systolic hypotension were less likely to survive to hospital discharge (40.5% vs. 72%; adjusted OR [aOR] 0.34; 95%CI, 0.12-0.93). There was no difference in survival to discharge by blood pressure groups for children treated with ECMO (30.4% vs. 49.3%; aOR = 0.60; 95%CI, 0.22-1.63).

CONCLUSIONS:

In this secondary analysis of the THAPCA-IH trial, in patients not treated with ECMO, systolic hypotension within 6 h of temperature intervention was associated with lower odds of discharge survival. Blood pressure groups in patients treated with ECMO were not associated with survival to discharge.

KEYWORDS:

Cardiac arrest; Child; Hypotension; Targeted temperature management

PMID:
31175965
PMCID:
PMC6650337
[Available on 2020-08-01]
DOI:
10.1016/j.resuscitation.2019.05.032

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